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Original Research: Sleep Disorders |

Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep

Sarah L. Appleton, PhD; Andrew Vakulin, PhD; Sean A. Martin, PhD; Carol J. Lang, PhD; Gary A. Wittert, MD; Anne W. Taylor, PhD; R. Doug McEvoy, MD; Nick A. Antic, MBBS, PhD; Peter G. Catcheside, PhD; Robert J. Adams, MD, MBBS
Author and Funding Information

FUNDING/SUPPORT: This study was funded by a National Health and Medical Research Council of Australia Project Grant (627227). Financial support for the conduct of sleep studies was also obtained from the ResMed Foundation, La Jolla, California.

aThe Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, SA, Australia

bFreemasons Foundation Centre for Men’s Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia

cAdelaide Institute for Sleep Health, a Flinders Centre of Research Excellence, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia

dSleep and Respiratory Medicine, Repatriation General Hospital, Southern Adelaide Local Health Network, Daw Park, SA, Australia

eThe NHMRC Centres of Research Excellence, CIRUS and NEUROSLEEP, Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, NSW, Australia

fPopulation Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia

CORRESPONDENCE TO: Sarah Appleton, PhD, Discipline of Medicine, The University of Adelaide, Queen Elizabeth Hospital, Woodville Rd, Woodville, SA, 5011, Australia


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):495-505. doi:10.1016/j.chest.2016.03.010
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Background  Evidence linking OSA with hypertension in population studies is conflicting. We examined longitudinal and cross-sectional associations of previously unrecognized OSA, including OSA occurring in rapid eye movement (REM) sleep, with hypertension.

Methods  The Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) study is a longitudinal study of community-dwelling men in Adelaide, South Australia. Biomedical assessments at baseline (2002-2006) and follow-up (2007-2010) identified hypertension (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg, or medication) and risk factors. In 2010 to 2011, 837 men without a prior diagnosis of OSA underwent full in-home unattended polysomnography of whom 739 recorded ≥ 30 min of REM sleep. Hypertension at follow-up (concomitant with OSA status) was defined as prevalent hypertension. Recent-onset hypertension was defined as hypertension at biomedical follow-up (56 months mean follow-up [range, 48-74]) in men free of hypertension at baseline.

Results  Severe REM OSA (apnea hypopnea index ≥30/h) showed independent adjusted associations with prevalent (OR, 2.40, 95% CI, 1.42-4.06), and recent-onset hypertension (2.24 [1.04-4.81]). Significant associations with non-REM AHI were not seen. In men with AHI < 10, REM OSA (apnea hypopnea index) ≥ 20/h was significantly associated with prevalent hypertension (2.67 [1.33-5.38]) and the relationship with recent-onset hypertension was positive but not statistically significant (2.32 [0.79-6.84]). Similar results were seen when analyses were confined to men with non-REM AHI < 10.

Conclusions  In men not considered to have OSA (AHI < 10), hypertension was associated with OSA during REM sleep. REM OSA may need consideration as an important clinical entity requiring treatment but further systematic assessment and evidence is needed.

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